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Thursday, April 12, 2012

A Year Ago: Bed 5, Round 4

first published on 4/12/2011

I had my first opportunity to serve as Ambassador of Ketamine yesterday, a duty that I discharged with vigor, if not honesty.

About a half hour before being escorted to the treatment area, ketamine patients are instructed to stop by the outpatient pharmacy, sidle nonchalantly on up to the counter and hit the pharmacist up for 10 mg of Valium.

I think nonchalant sidling is akin to the skedaddle of the detritus loving Fiddler Crab.

You ask for your Valium out of the side of your mouth; You cover your purchase with a bag of sour Skittles and maybe some Milk Duds; You pay your dollar, pop your pill, and go wait to be called for treatment.

So I'm in line, humming, fondling the candy. There is a guy in a wheelchair taking up a lot of time -- like, they tell him it will be a few minutes before his medication is ready, and he says okay, I'll just wait *here*... but, like, I can't get to the counter because he is entrenched, waiting *there*...

Jeez, people in wheelchairs think they own the world.

Fred does his clear-the-throat routine. That doesn't work because, heck, we're in the middle of a hospital where half the population has tubes running down their throats and the sound of raspy retching is the sound of normal.

I finally just call out over the guy's shoulder -- "Yo! I'm here to get my one-buckValium and to pay for these Skittles and maybe some Milk Duds before I go fall in my K-hole, yo, y'all."

At which point the guy in front of me practically does a wheelie.

"You, too, huh? This is my first time. I'm really nervous. Does it really work? What are you getting it for?"

Aw, fudge.

I'm nervous, myself, and this is my fourth treatment. And I am not feeling chatty, or excited, or even vaguely benevolent.

Nonetheless, I proceed to be a fine ambassador of subanesthetic ketamine infusion therapy for intractable pain. My routine is peppered (and salted) with plenty of "it varies from patient to patient..."

"Is it working for you? How long does it take before it works? Is it scary?" And so on, and so forth. I meet his Blessed Mother, who has blue helmet hair and clearly thinks I might be one of them "drug atticks." He rolls up his pants to show me his red lobster legs, trying to convince me that his pain is horrible, that he cannot sleep, that he's tried everything. I tell him he is obviously a cry baby, signal the money-grubbing pharmacist tech, peel off wide, and catch my neatly packaged diazepam on the fly. Fred tucks the candy into his backpack, I leave an IOU tucked in the Bowel Program For High Quadriplegia aisle (next to the cards and magazine rack), promise to settle accounts "next time," and we leave that big old cry baby and his helmet-headed mama with mouths hanging open, sucking in our dust.

When I am assigned an area back in the treatment room -- Bed 5 -- guess who is put in Bed 4? You guessed it! And his mama, too.

Big fat paralyzed cry baby seems to know every doctor and nurse who strolls by... and for some reason, people seemed to be taking their lunch-break power promenades down Ketamine Alley, peeking in at us weirdos and our wheelchairs, canes, catheters, ports, and world-weary loved ones valiantly trying to stay awake as lights and sounds dim, then mute. Fred and I listen to my neighbor bitch and moan as a namby pamby, softspoken, I-think-I-can-help-you type doctor attempts to tweek his spinal cord stimulator so that the cry baby can sleep long enough to have a wet dream. The doctor leaves him with several programs to try and some inspirational thoughts by Jack Handey.

I am the last person to be hooked up, even though I have the largest dose to be given. As usual, when I start the infusion, ketamine greets me with one of its more dependable effects -- a kind of sepia treatment, a brownish, sometimes greenish, tint or wash that rubs out details and crosses soft edges. That, and hearing so acute that I perceive Fred thinking of ducking out to grab a sandwich -- and his loud, booming hope for a kosher dill on the side.

Big fat paralyzed red-legged mama's boy cry baby, like many of us, has brought music to listen to in the form of an MP3 player. In fact, I had spent a fair amount of time during the night making a playlist specifically for the Ketamine Experience, hoping to avoid Jimi Hendrix and the Banner, "Knockin' On Heaven's Door" and stuff like the giggle-inspiring "Illegal Smile." Me and my 54 songs were ready for Round 4, all negativity purged, insipid pop privileged over mind-bending instrumentals, rock classics, and Mozart.

But now, in the cozy environs of Bed 5, there was this competing roar that I couldn't at first locate and never managed to silence. That's right -- the cry baby's music (if it can be called that! sniff:sniff) vibrated all over the damned place, bleeding from his earbuds. His taste in songs seemed to be limited to groups formed by cousins.

I apparently don't rise above a whisper during ketamine infusions. Fred has to lean in close to hear me and says that I perpetually inquire as to whether or not I am being too loud, and seek reassurances that I am not, in fact, shouting.

So there was that to contend with -- supersensitive hearing and leaky earbuds.

And yes, once again, I became hyperconcerned about a little old lady who was stashed in the last bed on Ketamine Row. She was moaning so, and weeping. Would these people never shut the hell up?

Part of the reason I was late getting started was that they accessed my portacath for the first time. Thankfully, that went fine, despite the nurse's contention that it was still too "infected" to use. The problem is now relegated to one tiny area of the incision, through which pokes this recalcitrant little stitch that refuses to "dissolve" and be absorbed by my body. Every few days or so, I clip the ends, and to keep things free of pus, crusty critters, and squishy maggots, first thing every morning and last thing at night, I douse the area with cognac and smear bacon grease over the wound, concentrating on that problematic corner.

Sorry. That's what I felt like telling the nurse every time she inquired whether or not I was applying neomycin, keeping it clean and covered, etcetera. It seemed she asked a hundred times and that was before the pharmacy even delivered the right dose of ketamine -- they had prepared a bag of 50 mg when I had graduated to 125, and the time required to correct the error was sufficient for her to worry enough about my site to page the doctor for "clearance" to use the port.

Clearly peeved at having been pulled from his clinic patients, he glared at me (not her, mind you, but me), poked at it meaningfully with an ungloved index finger, and declared it "perfect." Before dashing back to the crowded exam rooms and stacks of charts, he gave me a short pep talk, even using the word "miraculous" to describe the relief that would be coming my way any day now. Fred had a sneezing fit in the middle of the doctor's testimony, and I thought I saw the word bullshit fly out of his delicate aquiline nose and dance in the air before diving into his fine linen handkerchief.

If you are dying to know whether I got any pain relief from Round 4 of subanesthetic ketamine, you're not alone. So am I.

At 4:10 pm, I had no pain in my feet, no pain below my knees. I laughed, I smiled. I announced it. And then it was gone. No one reacted to my news, so I am not sure whether I actually said it out loud. Even when I retold the tale on the ride home, Fred didn't think I was serious.

When people describe how heartbreaking it is to have pain relieved only to have it return? There is no melodrama there. It really does tear the heart asunder -- bundles of ischemic cardiac muscle fall apart, shred, and twitch in extremis.

To answer the question, then, I don't know. I might have dreamed it, I might have hallucinated it, but at 4:10 pm, I had no pain in my feet, no pain below my knees.

All I can conclude is that maybe we are nearing the right dose of ketamine... I heard the nurse and the doctor discussing something about adjusting the rate but not the dose, but I am not sure they were talking about me.

The big fat paralyzed red-legged mama's boy cry baby next to me? When they inquired about his pain level following the infusion, he crowed -- "Zero! Zero, man, zero!"

His little blue-haired mama looked confused, but pleased, and announced that they were gonna go get them some Taco Bell.

My next treatment is set for next Wednesday at which time the dose will be 150 mg.

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ABOUT THIS BLOG

I am a retired French prof -- retired due to disablity, not age, and certainly not by choice. Teaching was my raison d'être. My world becomes more confined and defined with each passing day.

I hope that this blog, by its general silliness, alone, will prove a defense against the painful pressure of such implosions.

My interests are legion, but ultimately ego-driven, as will soon be embarrassingly evident. One of the more arcane? A love for the works of Georges Prosper Remi -- best known as Hergé. If you've forgotten the gist of Hergé's work, HERE is a list of characters and adventures to consult. How we wish, sometimes, that we had been in Hergé's Head (la Tête de Hergé), back in the heyday of Tintin, Snowy, Professor Calculus, Thomson and Thompson (Dupont et Dupond), and all the gang.

Still, it is a childhood dream come true to be living in Captain Haddock's ancestral manor, Marlinspike Hall, with my partner Fred, La Bonne et Belle Operatic Diva, Bianca Castafiore, our pets, and a devoted Domestic Staff. Bianca and I can be so much alike, at times, in ways both endearing and alienating, that you'll wonder "Who is whom?" While she has titular control of elle est belle la seine la seine elle est belle, I do most of the writing. If you would like to locate us on a map, it's easy: we are about a two hour drive west of the Lone Alp. Or you can use MapQuest.

Of course, even as the Milanese Nightingale regales us with longwinded tales of escapes from General Tapioca and poorly prepared pasta, saved by her beloved Captain and Tintin, even as she serenades us with that interminable Air des bijoux -- the threat of eviction looms over our heads, for we are neither manor born nor manor bred.

To stay in Captain Haddock's good graces and earn our keep, we strive to keep The Manor in tiptop shape, to keep the adventures to a minimum, and to be good neighbors to The Cistercians living just down the road, here in beautiful, magical Tête de Hergé (très décédé, d'ailleurs). You never know when The Captain might suddenly return from some mysterious nautical journey! The Castafiore trills merely at the thought; Fred, on the other hand, worries about the algae outbreak in the Moat, where our benefactor moors his mini-submarine fleet.

En tout cas...

Let me explain, at least, my blog title, Dear Reader:

Some years back, one early morning in Paris, bleary-eyed from a long flight, with hours yet to wait before I could check-in to my hotel (and perilously little money in my pocket), I stood perched against a stone wall overlooking the Seine.